In early September, the U.S. Home Training and Workforce Committee voted in favor of H.R. 9457, the Transparency Telehealth Payments Act. The invoice, launched by Rep. Aaron Bean (R-FL-04), acquired unanimous, bipartisan assist from committee members following adoption of an modification from Rep. Jahana Hayes (D-CT-05) that Bean welcomed as an “additional blanket of safety” for shoppers.
What Does the Transparency Telehealth Payments Act Do?
The Transparency Telehealth Payments Act limits telehealth billing in two key methods:
First, the invoice imposes a site-neutral billing requirement for telehealth companies paid for by group well being plans. No matter whether or not a well being care supplier is practising out of a hospital or an impartial setting, the plan should pay the identical quantity.
Second, due to the Hayes modification, the invoice prohibits hospitals from billing a separate facility charge when the well being care supplier is permitted to invoice independently for the skilled companies they rendered. This implies telehealth companies can lead to just one invoice.
Collectively, these provisions imply group well being plans and their plan members would obtain only one invoice for telehealth companies and the plan can pay the identical quantity regardless of the supplier’s location.
How Would This Have an effect on Client Out-of-Pocket Prices and Whole Spending?
For in-network care, shoppers needs to be shielded from the additional out-of-pocket prices that facility charges usually can generate. They could nonetheless face the danger of stability billing for out-of-network care if suppliers search better reimbursement than their plan pays (whether or not they’re primarily based at a hospital or not), as is normal at this time for any companies not protected beneath the No Surprises Act.
Whole spending by group well being plans may go down, however whether or not and the way a lot will rely on the extent at which plans pay for telehealth companies. The best profit will come if plans set their reimbursement stage on the quantity they’ve been paying for telehealth companies from impartial clinicians, somewhat than hospital-controlled suppliers that usually negotiate increased charges. As a result of the legislation doesn’t cap reimbursement at this quantity, plans should negotiate for it.
How Does This Invoice Evaluate to Different Business Facility Payment-Associated Reforms in Congress?
The Transparency Telehealth Payments Act is extra narrowly targeted than the opposite industrial facility charge ban proposed in Congress, each with respect to its limitation to telehealth companies and group well being plans solely. Senator Sanders and Marshalls’ Bipartisan Main Care and Well being Workforce Act would prohibit facility charge billing for analysis and administration companies and outpatient behavioral well being companies, along with telehealth companies. This invoice additionally doesn’t embody a distinctive supplier identifier requirement, which has appeared in each Home and Senate payments over the previous yr or so, and seeks to extend transparency relating to the situation of care in well being care claims.
On the identical time, this invoice is notable as the primary laws formally launched in Congress to carry the idea of site-neutral funds to the industrial sector. Senator Sanders floated a industrial site-neutral proposal in 2023, however finally launched his invoice with Senator Marshall that as a substitute prohibited facility charge billing for the companies recognized with out requiring that the quantity insurers pay for a similar companies be the identical in several settings. (Even when facility charges are prohibited, hospitals with market energy might negotiate better reimbursement for payments submitted by their suppliers.)
The place Will the Invoice Go from Right here?
Whereas it’s getting late within the yr to see new laws transfer, it’s potential this language (or one thing comparable) might get integrated into an end-of-year well being care bundle or a telehealth extender invoice. If it does, we might be watching to see whether or not its scope is expanded from solely group well being plans to incorporate the remainder of the industrial market, comparable to insurance policies bought by way of Reasonably priced Care Act marketplaces, or some other modifications are made. To higher perceive the completely different coverage choices lawmakers in search of to deal with outpatient facility charge billing could contemplate, try our Cheat Sheet for Policymakers. You can too look at our nationwide maps, detailing outpatient facility charge billing legal guidelines throughout the nation which may function a mannequin for federal lawmakers.
